Provider Demographics
NPI:1922632900
Name:JEREMY HOUTSMA COUNSELING LLC
Entity Type:Organization
Organization Name:JEREMY HOUTSMA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUTSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:201-638-0704
Mailing Address - Street 1:13654 SE BUSH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2936
Mailing Address - Country:US
Mailing Address - Phone:201-638-0704
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST STE 309
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3404
Practice Address - Country:US
Practice Address - Phone:503-567-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty